冠状动脉CT血管造影联合静息心肌透壁灌注指数诊断冠心病的临床价值研究

CT angiography(CCTA) in combination with resting transmural perfusion ratio(TPR) in diagnosis of coronary heart disease

目的探讨冠状动脉CT血管造影(CCTA)联合静息心肌透壁灌注指数(TPR)诊断冠心病(CHD)的临床价值。方法162例临床疑诊CHD的患者,CCTA后2周内完成冠状动脉血管造影(CAG)检查。利用CCTA的原始数据进行TPR分析,以CAG结果为参照,评价CCTA联合TPR对CHD的诊断价值。结果 CCTA、TPR单独或两者联合均可用于诊断CHD(x^2=94.42、14.25、48.30,均P<0.01),ROC曲线下面积分别为0.899、0.589、0.701。CCTA单独诊断CHD的灵敏度为85.6%(95/111),特异度为94.1%(48/51),阳性预测值(PPV)为96.9%(95/98),阴性预测值(NPV)为75.0%(48/64)。TPR单独诊断CHD的灵敏度为82.9%(92/111),特异度为45.1%(23/51),PPV为76.7%(92/120),NPV为54.8%(23/42)。联合CCTA及TPR诊断CHD的灵敏度为99.1%(110/111),特异度为41.2%(21/51),PPV为78.6%(110/140),NPV为95.5%(21/22)。结论联合CCTA及TPR可用于诊断CHD并可明显提高CHD诊断灵敏度。

Objective To evaluate the application of coronary CT angiography （CCTA） in combination with resting transmural perfusion ratio （TPR） in diagnosis of coronary heart disease （CHD）. Methods One hundred and sixty two clinical suspected CHD patients received CCTA examination with 320-row CT scanner, then underwent coronary angiography （CAG） within two weeks. TPR analysis was conducted from CCTA original data. One hundred and eleven patients were diagnosed as CHD by CAG. With CAG results as reference, the diagnostic value of CCTA in combination with TPR for CHD was evaluated. Results The areas under receiver operating characteristic curve （ROC） of CCTA, TPR and CCTA combined with TPR for diagnosis of CHD were 0.899, 0.589, 0.701, respectively （x^2= 94.42, 14.25, 48.30, P〈0.01）. The sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） of CCTA in diagnosis of CHD were 85.6%（95/111 ）, 94.1%（48/51 ）, 96.9%（95/98）, 75.0% （48/64）, respectively; those of TPR were 82.9%（92/111）, 45.1%（23/51）, 76.7%（92/120）, 54.8%（23/42）, respectively; and those of combined CCTA and TPR were 99.1%（110/111）, 41.2%（21/51）, 78.6%（110/140）, and 95.5%（21/22）, respectively. Conclusion CCTA in combination with resting TPR can improve the diagnostic sensitivity for coronary heart disease.